Compulsory Treatment for Anorexia Nervosa in Israel: Clinical Outcomes and Compliance.

Objective: Anorexia nervosa (AN) is associated with high morbidity and mortality rates, sometimes requiring compulsory treatment when patients refuse treatment despite life-threatening complications. Compulsory treatment of AN patients involving legal commitment is controversial in Israel, both ethically and legislatively. This study aimed to conduct a comprehensive retrospective examination of patient records to compare compulsory versus voluntary admissions regarding illness severity, admission, hospitalization, and outcomes.Method: Participants were 51 voluntary and 28 committed patients with severe AN admitted to a major Israeli ED department in 2003-2013. Demographic, clinical, physical, historical, and outcome data were collected through patients’ charts.Results: No significant group differences emerged between the groups in most variables. Two main differences were found: Committed patients had higher rates of comorbid personality disorders (33% vs. 10%) and significantly more disturbed nutrition patterns (44% vs. 26%) than voluntary patients. The two groups showed similar treatment outcomes in terms of weight gain (M = 9.7 kg), mortality rate (7.6%), and rehabilitation after hospitalization (15.2%).Conclusions: Results indicate that compulsory treatment may be as beneficial as voluntary treatment, both in the short and long term. After their initial resistance, compulsory patients were found to comply with the treatment and remain in the ED center to the same extent as those admitted voluntarily. Thus, compulsory hospitalization may reduce such patients' guilt about accepting nutrition and treatment. Compulsory treatment for severe life-threatening AN may save lives and should be implemented more commonly and earlier

Extreme Fragmentation in the Rey-Osterrieth complex figure test: a neuropsychological case study of a patient with anorexia nervosa

10.1007/s40519-014-0170-zEating and Weight Disorders202271-27

The complexity of the interaction between binge-eating and attention.

ObjectiveTo investigate whether binge-eating in patients with eating disorders (EDs) is associated with attentional deficits.MethodsWe studied ED patients with binge-eating (n = 51), no binge-eating (n = 59) and controls (n = 58). ED patients were assessed following the stabilization of weight and ED pathology. Attention assessment included evaluation of attention deficit hyperactivity disorder (ADHD) diagnosis, the Adult ADHD Self-Report (ASRS) and ADHD Rating Scale-IV-Home Version (ADHD-RS) questionnaires, and attention functioning assessed with neuropsychological tools. The severity of eating-related pathology, depression, anxiety and obsessionality was also monitored.ResultsPatients with binge-eating showed more ADHD symptomatology on the ADHD-RS compared with non-binge-eating patients. No differences were found between binge-eating and non-binge-eating patients in ADHD diagnosis and neuropsychological functioning. Among the specific ED subtypes, patients with anorexia nervosa binge/purge type (AN-B/P) showed the highest rates of ADHD symptomatology on the ADHD-RS, and were characterized with sustained attention deficits.ConclusionBinge-eating is not associated with attention deficits as measured by objective neuropsychological tools. Nonetheless, it is associated with attentional difficulties as measured with the self-reported ADHD-RS. AN-B/P patients are the only ED category showing objective sustained attention deficits

PAR1 signaling regulates the retention and recruitment of EPCR-expressing bone marrow hematopoietic stem cells

Retention of long-term repopulating hematopoietic stem cells (LT-HSCs) in the bone marrow is essential for hematopoiesis and for protection from myelotoxic injury. We report that signaling cascades that are traditionally viewed as coagulation related also control retention of endothelial protein C receptor-positive (EPCR+) LT-HSCs in the bone marrow and their recruitment to the blood via two pathways mediated by protease activated receptor 1 (PAR1). Thrombin-PAR1 signaling induces nitric oxide (NO) production, leading to EPCR shedding mediated by tumor necrosis factor-[alpha]-converting enzyme (TACE), enhanced CXCL12-CXCR4-induced motility and rapid stem and progenitor cell mobilization. Conversely, bone marrow blood vessels provide a microenvironment enriched with activated protein C (aPC) that retains EPCR+ LT-HSCs by limiting NO generation, reducing Cdc42 activity and enhancing integrin VLA4 affinity and adhesion. Inhibition of NO production by aPC-EPCR-PAR1 signaling reduces progenitor cell egress from the bone marrow, increases retention of bone marrow NOlow EPCR+ LT-HSCs and protects mice from chemotherapy-induced hematological failure and death. Our study reveals new roles for PAR1 and EPCR in controlling NO production to balance maintenance and recruitment of bone marrow EPCR+ LT-HSCs, with potential clinical relevance for stem cell transplantation

Clinical impact of Pseudomonas aeruginosa colonization in patients with Primary Ciliary Dyskinesia

Background: Airway infections in Primary Ciliary Dyskinesia (PCD) are caused by different microorganisms, including pseudomonas aeruginosa (PA). The aim of this study was to investigate the association of PA colonization and the progression of lung disease in PCD.Methods: Data from 11PCD centers were retrospectively collected from 2008 to 2013. Patients were considered colonized if PA grew on at least two separate sputum cultures; otherwise, they were classified as non-colonized. These two groups were compared on the lung function computed tomography (Cr) Brody score and other clinical parameters.Results: Data were available from 217 patients; 60 (27.6%) of whom were assigned to the colonized group. Patients colonized with PA were older and were diagnosed at a later age. Baseline forced expiratory volume at 1 s (FEV1) was lower in the colonized group (72.4 +/- 22.0 vs. 80.1 +/- 18.9, % predicted, p = 0.015), but FEV1 declined throughout the study period was similar in both groups. The colonized group had significantly worse CT-Brody scores (36.07 +/- 24.38 vs. 25.56 +/- 24.2, p = 0.034). A subgroup analysis with more stringent definitions of colonization revealed similar results.Conclusions: Lung PA colonization in PCD is associated with more severe disease as shown by the FEV1 and CT score. However, the magnitude of decline in pulmonary function was similar in colonized and non colonized PCD patients. (C) 2017 Elsevier Ltd. All rights reserved

Clinical impact of Pseudomonas aeruginosa colonization in patients with Primary Ciliary Dyskinesia

BACKGROUND: Airway infections in Primary Ciliary Dyskinesia (PCD) are caused by different microorganisms, including pseudomonas aeruginosa (PA). The aim of this study was to investigate the association of PA colonization and the progression of lung disease in PCD. METHODS: Data from 11PCD centers were retrospectively collected from 2008 to 2013. Patients were considered colonized if PA grew on at least two separate sputum cultures; otherwise, they were classified as non-colonized. These two groups were compared on the lung function computed tomography (CT) Brody score and other clinical parameters. RESULTS: Data were available from 217 patients; 60 (27.6%) of whom were assigned to the colonized group. Patients colonized with PA were older and were diagnosed at a later age. Baseline forced expiratory volume at 1 s (FEV1) was lower in the colonized group (72.4 ± 22.0 vs. 80.1 ± 18.9, % predicted, p = 0.015), but FEV1 declined throughout the study period was similar in both groups. The colonized group had significantly worse CT-Brody scores (36.07 ± 24.38 vs. 25.56 ± 24.2, p = 0.034). A subgroup analysis with more stringent definitions of colonization revealed similar results. CONCLUSIONS: Lung PA colonization in PCD is associated with more severe disease as shown by the FEV1 and CT score. However, the magnitude of decline in pulmonary function was similar in colonized and non-colonized PCD patients.status: publishe